Vision Quiz

COVD Quality of Life Checklist

To take the vision quiz, check the column which best represents the occurrence of each symptom.

Category

Symptom

Never

Seldom

Occas.

Freq.

Always

A

Blur when looking at near

A

Headaches with near work

A

Sees worse at end of the day

A

Difficulty copying from the Chalkboard

A

Avoids near work/reading

A

Holds head too close to the page

B

Has double vision

B

Words run together while reading

B

Eyes burn, itch, or seem watery

B

Falls asleep while reading

B

Closes one eye or tilts head while reading

OR

Dizzy or nauseous with near work

OR

Writes up or down hill

OR

Poor/inconsistent in sports

OR

Avoids sports/games

OR

Poor hand-eye coordination/poor handwriting

OR

Clumsy/knocks things over

OR

Car/motion sickness

OM

Skips or repeats lines when reading

OM

Misaligns digits/columns of numbers

P

Reading comprehension is poor

P

Trouble keeping attention on reading

P

Says “I can’t” before trying

P

Does not use his/her time well

P

Does not make change well with money

P

Loses belongings/things

P

Forgetful/poor memory

ALL

Difficulty completing assignments on time

ALL

Does not judge distance accurately

Your Final Score:

Score >20 — There is a high risk of having a vision problem that makes it difficult to read, to learn, to comprehend and even to pay attention. Further evaluation with a Comprehensive Vision Examination is recommended.

Schedule an Appointment

Vision Development Institute, P.C. is located in Pittsburgh just off a major interstate spur and serves the tri-state area of Ohio, West Virginia, and Pennsylvania. Call us at 1-412-731-5007 or email us at visiondevelopment1992@yahoo.com to make an appointment.